As a first-time mother, Charlene Covarrubias understood she had plenty to worry about over the course of her pregnancy: the brain fog, the emotional roller coaster from her body producing 100 to 1,000 times her usual concentration of hormones, the constant nausea that — contrary to its epithet — strikes not just in the morning, but any time of day. She had anticipated the mental and physical exhaustion of carrying a baby to term. What she didn’t realize was that the actual birth would cost her thousands of dollars.
Covarrubias is 32 and lives with her husband in Salt Lake City, Utah. She’d started saving to have her first child through her employer’s insurance and Health Savings Account long before she hit 26 weeks of pregnancy in October. She knew that having a baby would be expensive, that it would be stressful figuring out where the delivery would take place — maybe the University of Utah hospital in Salt Lake City or the Redwood Health Center, a clinic also in Salt Lake City. But once the bills for standard prenatal care screenings and checkups started stacking up in her third trimester, some individual visits nearing $1,000, she started to worry about the cost of that fateful hospital delivery bill more than any unknown that still lingered in the months ahead. “I don’t know what ‘covered’ looks like, to be completely honest,” she says. “It’s going to be covered to a point, but I know it’s still going to be a big bill.”
For the vast majority of people in the United States, it doesn’t just cost money to raise a child. It costs money to give birth. A lot of it. The Kaiser Family Foundation found that 19% of women are insured through Medicaid, which in most states covers prenatal care, ultrasounds, postpartum care and some delivery services. But the 72% of women who are insured through their employers, private coverage or Medicare are often still responsible for copays and deductibles that can add astronomical financial burdens onto families before they even begin paying the lifetime of expenses inherent to having a child. The average out-of-pocket cost for childbirth is nearly $3,000 for insured Americans. When complications arise, such as preeclampsia or the need for a cesarean section, that price can grow steeper by the thousands. No other nation in the world charges more. “It’s kind of similar to somebody who gets their degree and pays for it in loans, then they’re still paying off their loans in their job field,” Covarrubias says. “You’re still paying for the birth or delivery of your child while you’re preparing for the future.”
I don’t know what ‘covered’ looks like, to be completely honest. It’s going to be covered to a point, but I know it’s still going to be a big bill.
Last year, the fertility rate in the United States reached a record low of fewer than 1.6 children for every woman, as reported by the World Bank. The rate needed to sustain the current population without any decline is 2.1 kids per woman. Fears that a smaller population could fuel unemployment rates, labor shortages and poverty, diminish infrastructure and innovation, and strip welfare programs with fewer tax dollars to go toward Social Security have sent citizens and policymakers into a tailspin. Pew Research Center surveys show more than half of Americans believe this decline in births is going to negatively affect the state of the country, which has led to a slew of policy proposals like offering new moms $5,000 “baby bonuses” or reducing the cost of in vitro fertilization. Perhaps the most surprising, though, is the effort to make childbirth free for the first time in American history.
In May, Republican Sen. Cindy Hyde-Smith from Mississippi, Republican Sen. Josh Hawley from Missouri, Democratic Sen. Tim Kaine from Virginia and Democratic Sen. Kirsten Gillibrand from New York introduced the Supporting Healthy Moms and Babies Act. The bill requires that private insurers cover all costs related to childbirth from prenatal to postpartum care. It would make birth free for all Americans, not just those under Medicaid. “For a lot of people in the middle, where they make too much money to qualify for Medicaid but they don’t have great insurance, they’re facing some pretty substantial fees,” says Karen Guzzo, director of the Carolina Population Center at the University of North Carolina. “We need to make sure we’ve built a society where everyone has a chance of reaching stable circumstances that are widely considered to be appropriate for having children.”
We need to make sure we’ve built a society where everyone has a chance of reaching stable circumstances that are widely considered to be appropriate for having children.
The bipartisan bill has drawn support from groups that are otherwise diametrically opposed on matters of reproductive health, like the American Medical Association and Americans United for Life. Giving prospective parents the access and tools to start a family should they choose to do so is rare common ground that could act as a bridge between political aisles and get the nation on track with the rest of the developed world by advancing health care. It’s hailed as a step toward reversing a waning population, but in the context of what it means to afford life and family in the United States, it’s also a single cog in a much larger machine.
Despite the fact that billions of births have taken place over the course of human history, Emily Oster felt like it was easier to find questions than answers when she was pregnant with her daughter Penelope in 2010. Could she eat sushi? What about deli meat? Why wasn’t it easier to know what options she had, what advice to follow? She started to write down her queries and conducted research to answer them. That process is the basis for her 2013 book “Expecting Better,” and the reason she launched ParentData in 2020, a website and newsletter where expecting parents can find clear guidance.
Oster, who is also an economics professor at Brown University, knew firsthand that new parents are swamped with countless considerations. In the five years she’s run ParentData as its chief executive officer, she’s noticed many users are preoccupied with the economics of parenthood. “People think a lot about how kids are expensive,” she says. Yet the financial matters that take up most of their mental real estate revolve around long-term investments like schooling and pediatric care, not the upfront cost of delivery. Hundreds of videos on social media where new mothers break down their hospital bills after giving birth showcase that same truth — somehow, the cost of birth is universally mysterious for Americans, regardless of how childbirth remains the foremost reason for hospitalization nationwide. “Our health care is expensive because of the way that prices are negotiated,” Oster says, “and other things about our health care system that have nothing to do with birth specifically.”
A lack of transparency is a primary reason behind the elusive price tag. Like most services offered at hospitals, the cost of childbirth is extremely variable. What a parent pays out-of-pocket depends on factors like what insurance coverage they have. It also depends on what hospital they’re at, what that hospital charges for each billable expense — from room and board to the price per ibuprofen — and what specialists like anesthesiologists charge as their personal rates. Most insurance companies now offer portals where patients can find an estimate of what the procedure will cost them, but those estimates are based on averages and can’t account for specific circumstances.
That leaves a majority of parents unsure what delivery will cost them until they receive an itemized bill. Hospitals have made headlines for charging parents who want to hold their child after a cesarean section $40 “skin to skin” fees. A 2021 study in the JAMA Health Forum found about 1 in 5 parents cite their unusual charges average more than $700 on their final hospital bill, while a third are hit with thousands of dollars in surprise charges. Another in the Milbank Quarterly found that 40% of people who spend more than $1,000 on out of pocket expenses for a commercially insured birth then worry about affording health care bills. One in 5 respondents who make less than $60,000 a year even had medical debt in collections as a result. “The price can be twice as high for two different patients in the same hospital, depending on the negotiated rates between that provider and that patient’s insurance,” says John Hargraves, director of data strategy at the Health Care Cost Institute in Washington, D.C. “It’s unlike almost anything else we purchase. You can’t cost compare. There’s no Costco alternative.”
Americans spend nearly double the amount on health care per person than citizens of any peer nation. The insurance landscape is notoriously complex and operates largely outside of government control, which means there are effectively no checks and balances on what profit-driven hospitals can charge patients. Nearly 70% of the world’s population has some form of universal health care — especially in developed nations — and several countries cover childbirth as an inpatient admission. Should the Supporting Healthy Moms and Babies Act become law, it would classify prenatal care, postpartum care and birth as essential services under the Affordable Care Act. Insurance companies would eat the cost, and although premiums would increase, it would only cost policyholders an estimated $30 more each year.
For first-time parents like Covarrubias, the thought of scrounging up $30 more each year instead of thousands of dollars upfront feels encouraging. For those on the fence about starting a family, maybe even more so. It’s no wonder then that it’s attracted both the ideologically left and right; whether framing the bill as expanding health care access and social service or framing it as a pronatalist push to procreate, families could stand to grow and benefit because of it. If it materializes.
After the Supreme Court made the bombshell decision to overturn Roe v. Wade in the summer of 2022, a vacuum suddenly appeared within a reproductive rights debate that had been so singularly focused for half a century. The Atlantic staff writer Elizabeth Bruenig wrote a piece in an attempt to chart a path forward with a new legislative priority: free childbirth in the United States. It directly inspired a proposal that acted as a predecessor to the Supporting Healthy Moms and Babies Act in 2023 and built the political momentum necessary for the present push.
The things that matter most are child care infrastructure that is affordable, accessible, high quality and paid leave.
This new reproductive reality arrived in tandem with a steadily declining fertility rate, projected cuts to Social Security within the next decade, historically low participation in the armed forces, more than half of the nation’s farmers aging out of work without replacements, and a destabilizing economy. The mishmash prompted a belief that America’s social structure is built for a population that grows, or at least stays steady, not one that shrinks. Guzzo points to evidence that the declining fertility rate doesn’t pose immediate or catastrophic consequences, but the alarm can’t be unrung. “The evidence suggests that people generally still want to have kids,” she says. “People just don’t feel good about their lives. And I think what’s important about that is, having a child is making a long-term commitment to the future. … I don’t think people’s futures feel very predictable right now.”
As well rounded as support for free childbirth is, it’s not universally held as the most effective solution to build and support families. A majority of adults find more tax credits for parents, required paid family leave and free child care more urgent. Gen Z and millennials are facing one of the worst labor markets in years. Americans owe nearly $1.8 trillion in student loans, and some nine million defaulted on their loans in 2025 alone. Most can’t afford to buy homes. Head Start, a federal child care program that serves more than 730,000 low-income families, is targeted for budget cuts.
Guzzo suggests social services that ease the financial burden of long-term investments, more than one-time costs like hospital delivery, are better incentives for younger generations to feel safe starting families. “The things that matter most are child care infrastructure that is affordable, accessible, high quality and paid leave,” Guzzo adds. “They boost the total fertility rate by about 0.1 to 0.2%, which doesn’t sound big, given that we’re at 1.6 and that would get us to maybe 1.8, but that’s still hundreds of thousands of births.” Though paid leave and free child care are far more ideologically contentious among lawmakers than free childbirth.
Regardless of what the future holds for reproductive policy, Covarrubias has to confront her own due date in the winter. It will cost her. She’s hopeful that cost won’t set her back too much, that whichever hospital she chooses to give birth at doesn’t embellish her final bill with surprise charges. She’s even more hopeful that her daughter will grow up to have more options than she did. That’s all any parent can do. Besides, Covarrubias has access to emotional support from the strong women in her family, and material support through her insurance. “I think I’m one of the more fortunate ones,” she says.
This story appears in the December 2025 issue of Deseret Magazine. Learn more about how to subscribe.